P50 Staphylococcus Lugdunensis Endocarditis: Multicenter Study of 17 Cases (original) (raw)
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Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature
Mycopathologia, 2014
Background Fungal endocarditis (FE) is a ''modern'' disease that is considered an emerging cause of infective endocarditis (IE). The most frequently identified fungal pathogens are Candida spp., which are responsible for up to two-thirds of all cases; the remaining cases are due to Aspergillus spp., Histoplasma capsulatum or, more rarely, other yeasts and moulds. Objectives To describe the prevalence, clinical characteristics and outcome of FE diagnosed in a single tertiary centre and review the literature concerning FE. Design and setting An 8-year retrospective review of the case records of patients attending a single Italian University Centre and diagnosed as having definite or probable IE as defined by the modified Duke criteria. Results Six patients were identified from 229 episodes of IE: five cases involved a prosthetic valve, and one a native valve of an intravenous drug user. Five cases were caused by Candida spp. (two by C. albicans, one each by C. lusitaniae, C. dubliniensis and C. glabrata) and one by Aspergillus flavus. Three patients were treated by means of surgery plus antifungal therapy; two received antifungal therapy alone. Three patients survived, but only the patient with Aspergillus endocarditis was followed up for a long time. Conclusions FE is difficult to diagnose but generally associated with healthcare infections. The optimal treatment is poorly characterised, and international collaborative studies are urgently needed to evaluate newer antifungal agents. Keywords Fungal endocarditis Á Aspergillus spp. Á Candida spp. Á Histoplasma spp. Á Literature review Á Galactomannan antigen Á 1,3-b-D-Glucan antigen Á Prosthetic valve endocarditis
Incidence and outcome of documented fungal endocarditis
International cardiovascular research journal, 2014
Fungal endocarditis, the most severe form of infective endocarditis, is characterized by excessive mortality and morbidity. The present study aimed to analyze the characteristics of fungal endocarditis to improve the management of these patients. In this cross-sectional study, vegetations on the mitral or tricuspid valves and embolic material surgically removed from the patients with suspected infective endocarditis between December 2009 and November 2011 were examined for fungal infection by direct smear and culture, and the susceptibility patterns of the isolated species were determined. Then, blood samples were cultured on BACTEC media and real-time PCR was done with blood and tissue samples. Of the 31 patients with suspected infective endocarditis who did not respond to antibacterial therapy, 11 had confirmed fungal endocarditis. The most frequent predisposing risk factors were previous surgery and drug abuse. The organisms isolated were Aspergillus spp. and Candida albicans. Re...
Outcomes in patients with fungal endocarditis: A multicenter observational cohort study
International Journal of Infectious Diseases, 2018
To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for inhospital mortality in patients with Candida sp endocarditis. Methods: A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality. Results: Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p = 0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p = 0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p = 0.027) and exclusive medical treatment (odds ratio 11.1; p = 0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p = 0.023). Conclusions: Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.
PloS one, 2018
Fungal Endocarditis (FE), a relatively rare disease, has a high rate of mortality and is associated with multiple morbidities. Aspergillus endocarditis (AE) is severe form of FE. Incidence of AE has increased and is expected to rise due to an increased frequency of invasive procedures, cardiac devices and prosthetic valves together with increased use of immune system suppressors. AE lacks most of the clinical criteria used to diagnose infective endocarditis (IE), where blood culture is almost always negative, and fever may be absent. Diagnosis is usually late and in many cases is made post-mortem. Late or mistaken diagnosis of AE contribute to delayed and incorrect management of patients. In the current study we aimed to describe the clinical, laboratory and imaging characteristics of AE, to identify predictors of early diagnosis of this serious infection. Patients with definite/possible IE, as diagnosed by the Kasr Al-Ainy IE Working Group from February 2005 through June 2016, were...
Aspergillus Valve Endocarditis in Patients without Prior Cardiac Surgery
Medicine, 2000
From Depart ment s of Inf ect ious Disease (TG, AJT, SM, MCM, SMG) and Cardiot horacic Surgery (BHL, DMC), The Cleveland Clinic Foundat ion, Cleveland, Ohio. Addr ess r epr i nt r equest s t o: St even M. Gor don, MD, Depart ment of Inf ect i ous Di sease, S32, Cl evel and Cl i ni c Foundat i on, 9500 Eucl i d Avenue, Cl evel and, OH 44195. Fax: 216-445-9446; e-mai l : gor dons@CCF. ORG.
Fatal Prosthetic Valve Endocarditis Due to Aspergillus flavus in a Diabetic Patient
Infection and Drug Resistance
Aspergillus endocarditis (AE) accounts for a-quarter of all fungal endocarditis, mainly in immunocompromised hosts prior to heart-valve surgery with high mortality, even with treatment. Herein, we report a rare case of AE in a diabetic 60-year-old woman with a history of redo mitral valve prosthesis suspecious of acute endocarditis. She underwent second redo surgical mitral valve replacement in combination with mechanical aortic valve replacement. Blood cultures were negative. The explanted valve and vegetation were subjected to identification. Grown colonies were identified as Aspergillus flavus, based on conventional and molecular methods. Despite the administration of liposomal amphotericin B and improvement in her general condition shortly after initiation of therapy, the patient passed away. As AE is a late consequence of redo prosthetic valve replacement, extended follow-up, early diagnosis, repeating valve-replacement surgeries, and timely selective antifungal treatments are warranted.
Fungal Endocarditis: Evidence in the World Literature, 1965-1995
Clinical Infectious Diseases, 2001
We analyzed 270 cases of fungal endocarditis (FE) that occurred over 30 years. Vascular lines, non-cardiac surgery, immunocompromise and injection drug abuse are increasing risk factors. Delayed or mistaken diagnosis (82% of patients), long duration of symptoms before hospitalization (mean ע standard deviation, days) and extracardiac manifestations were characteristic. From 1988 onwards, 72% of patients were 32 ע 39 diagnosed preoperatively, compared with 43% before 1988 (). The fungi most commonly isolated P p .0001 were Candida albicans (24% of patients), non-albicans species of Candida (24%), Apergillus species (24%), and Histoplasma species (6%); recently-emerged fungi accounted for 25% of cases. The mortality rate was 72%. Survival rates were better among patients who received combined surgical-antifungal treatment, were infected with Candida, and had univalvular involvement. Improvement in the survival rate (from !20% before 1974 to 41% currently) coincided with the introduction of echocardiography and with improved diagnostic acumen. Fungal endocarditis recurs in 30% of survivors. It is recommended that fungal endocarditis be diagnosed early through heightened diagnostic acumen; that patients be treated with combined lipid-based amphotericin B and early surgery; and that patients be followed up for у4 years while on prophylactic antifungal therapy.
Candida parapsilosis endocarditis: a comparative review of the literature
European Journal of Clinical Microbiology & Infectious Diseases, 2007
Fungal endocarditis (FE) is an uncommon disease, and while accounting for only 1.3-6% of all cases of infectious endocarditis, it carries a high mortality risk. Although Candida albicans represents the main etiology of FE, C. parapsilosis is the most common non-albicans species. We report the case of a 32-year-old man with a history of prior intravenous drug (IVD) use hospitalized with endocarditis due to C. parapsilosis and review all 71 additional cases documented in the literature. A retrospective analysis of the 72 C. parapsilosis cases compared to 52 recently reviewed cases of C. albicans endocarditis was conducted to identify organism-specific clinical peculiarities. The most common predisposing factor for C. parapsilosis endocarditis (41/72; 57.4%) involved prosthetic valves followed by IVD use (12/72; 20%). Peripheral embolic and/or hemorrhagic events occurred in 28/64 (43.8%) patients, mostly in cerebral and lower limb territories. Overall mortality was 41.7%. Combined surgical and clinical treatment was associated with a lower mortality. Few patients received the newer antifungal agents, and it would appear that more experience is required for their use in the treatment of C. parapsilosis endocarditis. Eur J Clin Microbiol Infect Dis (2007) 26:915-926
International Journal of Advanced Research (IJAR), 2024
Infectiveendocarditisisdefined as an infection of one or more heart valves by bacteria, more rarely by intracellulargerms or yeasts. Involvement of the parietalendocardiumislesscommon. Infectiveendocarditisis rare but serious (1). Even rarerisfungalendocarditis of the rightsideheart. We report here the case of afemale 48-year-old patient withcrohnsdiseaseunder immunosuppressive therapyadmitted to intensive care for management of a febriledisorder of consciousness. Biological and radiological investigations revealedavegetation of the tricuspid valve and candida fungemia, indicating a diagnosis of fungalendocarditis of the right heart. The patient was put on fluconazole 800mg/daywith a good initial course, followed by a worsening of herclinical and biological condition in connectionwithpulmonaryempyema and a nosocomial infection withmulti-resistantacinetobacterbaumanii, whichcompromisedherprognosis. The patient died in multiple organfailure. Certain riskfactors, such as intravenousdrug use, immunodepression and intravenouscatheters, predispose to both right-heart and fungalendocarditis. The clinicalpresentationis not verydifferentfromthat of the leftheart, but specialmethods are needed to detectit. Treatmentisessentiallybased on antifungal agents and surgery.